How to Get Comfortable Sleeping with Back Pain

Learn why what you sleep on and how you sleep can be aggravating your back.

By Ashley Little

Jul 13th, 2022

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Medically Reviewed by Dr. Brooke Dulka, a medical writer and neuroscientist who received her Ph.D. in biological psychology from the University of Tennessee, and she is currently a postdoctoral researcher at the University of Wisconsin-Milwaukee where she studies the neurobiology of memory.

Have you ever wondered why you wake up sore in the morning? Perhaps you’ve wondered why you have trouble getting comfortable at night or why you wake up feeling restless in the morning. When it comes to battling the discomfort of back pain, believe it or not, your mattress or sleeping position could be to blame.

At Mattress Advisor, we set out to understand why a mattress of poor quality could be the cause of bodily aches and pains and how to fix problems like poor sleeping posture that occur when your unconscious. But we couldn’t do it alone. We’re experts in finding the best mattresses, but not as much when it comes to the medical intricacies of back pain.

With the help of Dr. Scott Bautch, D.C., D.A.C.B.O.H., C.C.S.T, C.C.S.P., president of the American Chiropractic Association Council on Occupational Health, Dr. Travis Russell, D.C., Director of Chiro One Wellness Center of Naperville, and Dr. Ben Kersenbrock, D.C. who is the owner of Kersenbrock Chiropractic, we were able to solve our curiosities about how sleep is related to chiropractic health.

Common Causes of Back Pain

“Back pain is not to be taken lightly- its the single leading cause of disability worldwide, so its important to ensure you’re using a mattress that benefits your physical health and supports a healthy back,” says Dr. Brooke Dulka.

Worldwide, back pain is the single leading cause of disability. In America alone, 31 million people experience back pain at any given time, according to the American Chiropractic Association.

At the root of the problem, back pain is experienced when ligaments are sprained, muscles are strained, disks are ruptured, or joints are irritated. There are countless causes of back pain, some of which include, arthritis, poor posture, injury, obesity, and stress. But there are two other culprits that seem too fly under the radar: your mattress and your sleeping position.

Dr. Scott Bautch has practiced chiropractic health for 30 years. He told us that if a patient comes to him with any type of back pain, he always asks about their mattress. Dr. Travis Russell said he doesn’t go a single day without having a conversation with a patient about how they’re sleeping or what their mattress is like when discussing their pain symptoms.

Why then, do we refuse to look more closely at the mattress we are sleeping on when trying to solve back pain problems?

A Mattress’s Impact on Back Pain

First, let’s get something straight: a mattress is a healthcare product that is vital for optimum physical health.

“There is nothing that could be more important for you than a mattress,” Dr. Bautch says. That’s because our mattress is the performance tool we use to get our best sleep. The quality of our mattress directly impacts our quality of sleep and, ultimately, our quality of life.

Dr. Russell put it like this:

“We are constantly battling some form of stress 100% of every day and night, be it physical, chemical or emotional stimuli.  Our bodies have the ability to resist and adapt to the vast majority of those stressors. However, there is a recovery period that we must go through in order to prepare ourselves for the next stressful encounter. If we are battling additional physical stresses from an unsupportive or improper mattress while we sleep then our bodies’ recuperative abilities are diminished. A poor mattress will affect our ability to recover from the stressful stimuli which, when sleeping on a poor mattress for hours every night, will lead to a state of physical exhaustion.  It’s in this phase that physical symptoms present themselves. These symptoms, any symptoms, are your bodies’ natural warning signs that something is not functioning properly. A good mattress will allow for a higher rate of recovery and adaptation to the daily stressful stimuli that can occur.”

Yet, we don’t put much thought into what we are sleeping on. When our bed becomes uncomfortable, we throw on a mattress topper and call it good, which is the equivalent of spray painting a dead bush green and calling it alive. It’s because of this attitude of apathy that the structure designed to aid in recovery has often become the cause of aches and pains itself.

Why Mattress Support Matters

Here’s the thing. Your mattress is most likely not 100% of the problem, but it could definitely be part of the problem. If you wake up with a stiffness that continually progresses, that’s a pretty good indication your mattress is contributing to your soreness and back pain. In any case, a mattress that promotes a healthy back starts with proper support.

Since a young age, we have been taught that posture is important. We’ve learned to sit up straight and put our shoulders back; that hunching over a laptop or book can hurt your back. What most of us haven’t been told is that posture is still important when we are asleep.

A mattress’ ability to keep your spine in alignment is very important when it comes to pain management. But sometimes a mattress can ‘hammock’ a person, creating a pinch point in the lower lumbar spine, which provokes issues of chronic pain.

The mattress has to give at the hips but come up to the mid-section to keep the spine in neutral. If it sags in the middle or are pushed up too high, you’ll throw the spine out of neutral alignment. “Spine alignment is crucial in relation to pain management and helps promote healthy posture,” says Dr. Dulka.

Most people don’t realize just how important spine alignment is—many chiropractic issues stem from the spine. For example, if a patient has pain in the hips, most of the time the problem stems back to an issue with the spine. This hip issue can then lead to a leg issue, and so on.

There are two primary factors that determine a mattress’ level of support: age and materials.


“The age of your mattress makes a huge difference,” Dr. Bautch informs us. “If your mattress is older than 5-7 years, no matter how much you paid for it, it’s probably time for something new.”

If you are sleeping on a budget mattress, that time frame is even shorter (more like 1-3 years). If you’re struggling with either chronic or acute low-back pain, assess your sleeping structure. Have you noticed a sag or dip towards the middle of the bed? If so, this indicates your bed is creeping up in years and that’s probably contributing to your pain problem.

Materials and Construction

The materials used to construct the mattress are also important for support. The better the quality of materials used in your mattress, the more support it will give and the longer it will last. The biggest difference between a budget mattress, which will cost roughly $500 or less, and a mattress that retails for $800 or more is the quality of materials and construction. Keep in mind, mattresses manufactured in the US are held to a higher standard for the quality of materials used. The better the materials used to make your mattress, the better the support.

When assessing the quality of the materials in a mattress, Dr. Bautch recommends paying close attention to the type of innersprings and foam used. His advice is as follows:

  • Springs: Spring size and count have a big impact on the level of support the bed provides. “The bigger the springs, the less [the mattress will] conform to your side or back. The smaller the springs the more they adapt to your body type. You’ll want as many small springs as possible.”
  • Foam: Dr. Bautch is sometimes weary of memory foam because it can break down really fast. However, he acknowledged there have been huge improvements in memory foam mattresses over the years.

Spring and memory foam mattresses are by no means the only type of mattresses for sleepers with low-back pain. We all have different body types, sleeping styles, and comfort preferences and the best mattresses for back pain reflect that. The key is to find a quality mattress that provides proper support for your physical needs. For how much time we spend sleeping, putting thought into your mattress selection is very important.

Matching Mattress to Body Type

Speaking of body types, just like we shop for shoes that fit our feet, we need a mattress that supports our specific body type. One size does not fit all.

In Dr. Bautch’s 30 years of practicing as a chiropractor, he has had nearly 25,000 patients. Of those 25,000 patients, at least 50% have not matched their mattress to their body type or received advice on how to do that. This can be detrimental to sleep and back health.

Related: Best mattress for hip pain

Besides the age of your mattress and the quality of the materials in it, there are a number of other factors to consider when looking for a good mattress for your back. One of the most important is weight.


Weight has a huge impact on the type of mattress you should be sleeping on. A mattress will not support a 6’ 4’’, 280 lb. male the same way it will support a 5’ 4’’, 130 lb. female. People weighing more than 200 pounds are considered larger than average. At this weight, sleepers begin to need certain mattress features that are less important to average-sized sleepers. Some of these include thickness, weight limit, edge support, and firmness. Heavy sleepers are more likely to sink into their mattress; therefore, they need to look for high-density materials and deep compression support. Otherwise, they will be quick to experience issues with back pain.


If you sleep with a partner, you need to think about their body type too. It’s very likely you’ll need completely different mattresses depending on how similar or different your body types are. If this is the case, you may need something customizable. That way, both of your physical needs and comfort preferences can be met.

Sleeping Position and Back Pain

Your mattress isn’t always the culprit when it comes to waking up with aches and pains. The issue could actually be you — more specifically, your sleeping position. But how do you fix a problem that occurs when your unconscious? That’s what we asked the docs.

The Best Sleeping Positions for Your Back

Sleeping position is very important when it comes to pain management and getting a good night’s sleep, for that matter. We ranked the sleeping positions, back, stomach and side, from best to worst for your health:

First Place: The Back

All of our experts unanimously agreed— sleeping on your back is the best position for your chiropractic health, hands down. Your body rests most naturally in this position, which reduces the amount of stress on your spine and neck.  

“The best sleeping position for your spine is on your back with your legs extended,” Dr. Kersenbrock, D.C. tells us. 

Dr. Bautch adds that this position allows:

  • Our digestive system to reset
  • The healing phase of sleep to occur (any interruption of sleep takes the resources you need for healing sleep away)
  • Hormone levels to regulate

You should know that even if you sleep on your back, it doesn’t mean your posture is 100% in the clear. For example, sleeping on your back with your pelvis twisted can cause problems. The most important thing to aim for is keeping your pelvis and spine in alignment.

Are you a back sleeper? See the best mattresses for back sleepers.

Second Place: The Side

If you can’t sleep on your back, our experts would suggest sleeping on your side next. After all, most people are side-sleepers. The reason sleeping on your side is not as good as sleeping on your back is because it puts pressure on your hips and shoulders.

Sleeping on your side can put a rotational force on the lower back, which can cause aggravation in the lower lumbar spine. We also tend to hunch the shoulders when on our side which can cause tight pecs.

Related: Best mattress for side sleepers

If you are a side sleeper, it’s important to make sure your neck is square to your shoulders and not sagging to one side. The implications of this is a muscular issue. It can create impingements of the joints in your neck. These impingements cause pain and tightness in the neck and under the arms.

Learn more about the best mattresses for side sleepers.

Last Place: The Stomach

That leaves stomach sleepers. Sorry guys, but our docs confirmed this is the worst position to sleep in by far. Sleeping on the stomach causes you to hyperextend your back and puts pressure on the knees. Hyperextension can strain the ligaments in the back of your spine.  Additionally, this position forces you to crank your neck to one side, which causes your muscles to tighten.

It’s rare you’ll find a doctor who recommends sleeping on your stomach; however, given certain situations, it might be the best option for someone. In some cases, you just can’t help it.

If you are a stomach sleeper, use this guide to find the best mattresses for you.

How to Tell if Your Sleeping Position Is Causing Back Pain

If you wake up more stiff than when you went to bed, that’s a pretty good indicator your sleeping posture could be to blame, but it could also be the mattress itself. Perhaps, the best indicator is if you wake up in an awkward position. Regardless of whether it’s your sleeping position or mattress, if you are constantly waking up throughout the night from discomfort, then something is definitely going on. Anything that keeps you from restful sleep should be addressed.

Sleeping Position Modifications

No chiropractor or physical therapist can change their patient’s sleeping position, but they can give them modifications to help them stay in a healthy posture or get comfortable quicker if they experience pain. The main objective of the following modifications is to take pressure of certain parts of the body, like the back, neck, hips, and shoulders or to keep you still in one position.

Modifications for Back Sleepers

  • Keep your hips square to prevent a twist in the pelvis.
  • If you experience low-back pain regularly, put a pillow under your lower legs to decrease tension on the hamstrings which minimizes pull on the pelvis and lower back. Like we said, everything is connected!
  • Place pillows by your hips to keep from rolling over (so you stay in a neutral position).

Modifications for Side Sleepers

  • Our chiropractors agree that even if you sleep on a good mattress, you should place a pillow between your knees if you sleep on your side. Our hips are wider than our knees so we need a pillow to keep the hips square and pelvis aligned. “If a patient is sleeping on their right side, then the left leg will angle down from the hips to the knees thus placing additional stress on the muscles of the thighs, hips, and lower back.  Spacing out the knees to keep that angle at a minimum will decrease those stresses,” Dr. Russell shares.
  • If you have mid-back pain, hug a pillow to keep shoulders from caving in.

Modifications for Stomach Sleepers

  • If you can, try sleeping in a different position altogether.
  • If not, place a pillow under your pelvis. This will help keep your back in a more neutral position and take pressure off your spine.
  • Stretch in the mornings. A few minutes of stretching will help get your body back in alignment and gently strengthen supporting muscles.
  • Use a thin pillow or no pillow at all. The flatter the pillow, the less angled your head and neck will be.

Related: Best pillow for back pain

The Importance of Solving Your Back Pain Problem

“If you continue to sleep on an improper mattress, your problems will be exacerbated. Even worse, a poor quality mattress won’t allow you to sleep and heal,” says Dr. Kersenbrock, D.C. 

One of the most troubling consequences is an increase in pain and discomfort. The more sleep we lose, the less likely we are to heal. When we aren’t sleeping, we are putting our muscles to work. This lack of rest increases fatigue and soreness. Proper sleep gives our muscles and joints the endurance they need to face the following day.

Sleeping on a mattress of poor quality and having poor sleeping posture will continue to cause joint breakdown and irritation long term. Prolonged inflammation of the joints speeds up the degenerative process.

When it comes to cracking the code on back pain, pay close attention to how you are sleeping and what you are sleeping on. Once you know these things, your doctor can help steer you in the right direction.

Expert Bios

Dr. Scott Bautch, D.C., DACBOH, CCST, CCSP

Dr. Scott Bautch is past chairman of the Board and past CEO for Allied Health Chiropractic Centers, a Wisconsin-based chiropractic corporation comprised of more than 50 individual clinics. Dr. Bautch is president of the American Chiropractic Association’s Council on Occupational Health. He has also served as a board member for the International Academy of Chiropractic Occupational Health Consultants and is a past chairman of the Wisconsin Council on Occupational Health. Dr. Bautch completed his undergraduate studies at the University of Wisconsin-LaCrosse in 1980 and graduated from the Logan College of Chiropractic in 1983. He is certified by the American Chiropractic Board of Occupational Health, maintains certification in Chiropractic Spinal Trauma, and is a certified Chiropractic Sports Physician.

Travis Russell
Dr. Travis Russell. D.C.

Chiropractic Director of Chiro One Wellness Center of Naperville, Dr. Travis Russell, D.C., holds a bachelor’s degree in kinesiology from the University of Illinois, as well as a bachelor’s degree in life science and a doctorate of chiropractic from Logan College of Chiropractic. Dr. Russell firmly believes all people deserve to lead healthier lives and the key to being successful is chiropractic care.

Dr Ben Kersenbrock DC
Dr. Ben Kersenbrock, D.C.

Dr. Ben Kersenbrock received his doctorate in chiropractic from Palmer College over a decade ago. He’s the founder and lead chiropractor at Kersenbrock Chiropractic in Lake Mary, Florida, an integrative wellness center offering chiropractic care, acupuncture, massage, assisted stretching, and more.

Dr. Brooke Dulka
Dr. Brooke Dulka

Dr. Brooke Dulka is a medical writer and neuroscientist. She recieved her Ph.D. in biological psychology from the University of Tennessee, and she is currently a postdoctoral researcher at the University of Wisconsin-Milwaukee where she studies the neurobiology of memory.